Individual
DR. JOHNSON H KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 E GROVER ST, SHELBY, NC 28150-3917
(980) 487-4721
(980) 487-3942
Mailing address
PO BOX 1689, ETOWAH, NC 28729-1689
(828) 891-5524
(828) 891-4069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
23578
NC
208800000X
Urology Physician
Primary
23578
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230126
MEDICARE PTAN
NC
01
—
23578
NC MEDICAL LICENSE #
NC
01
—
48217
BCBS ID
NC
05
—
8948217
—
NC
Enumeration date
08/15/2006
Last updated
02/10/2011
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